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Politics: The Senate voted Monday to move forward with the Employee Non-Discrimination Act (ENDA) in a misguided effort to ensure gay rights in the workplace. All it will do is heap chaos — and costs — on business.
With everything from health care to immigration a non-starter in Washington, it's no surprise that Democrats are now scraping bottom with a badly designed law intended to end supposed widespread job discrimination against gays, lesbians, bisexuals, transgenders and others known as "questioning."
But there's no pressing need for such legislation, given the existing protections of the Civil Rights Act as well as the truly widespread acceptance in society of gay and other sexual minorities. What's more, employers already have incentives to tolerate good employees without regard to their sexual orientation, because good employees are critical to profitable businesses.
But ENDA isn't about changing attitudes, or ensuring flourishing businesses.
Everything about it is a chaos agent that's likely to trample first freedoms and trash business efficiency through new bureaucratic and tort nightmares.
For one, ENDA isn't focused on protecting the sexual identities of employees, as the Civil Rights Act is, but on extending to particular behaviors associated with unconventional sexuality new protected privileges, notes the Heritage Foundation and other observers.
So under ENDA, if a male kindergarten teacher shows up to work dressed like a woman, nothing would shield children from that introduction to new sex identities.
Males who declare themselves women would be free to use women's restrooms, and any employer who tries to protect objecting female employees would face lawsuits from either the male or the females.
Christians and people of other faiths who refuse to accept gay marriage would become targets for enforcement, clearly in violation of their faith, despite a weakly written religious protection.
And don't imagine gay businesses couldn't be targeted too — the law could force a gay bar owner in West Hollywood to hire an unsuitable Christian on the same logic.
The bottom line is, while virtually all Americans are against abusive behavior against gays, this law restricts society's right to organize and assemble itself along the lines of its choosing. It's nothing but a costly and intrusive fetter on business — and it ought to be scrapped.
American Decline: Chinese forces head to Syria to join with Russia in filling Obama's power vacuum and purportedly fight the Islamic State. A false move involving NATO member Turkey could mean world war.Russian and Chinese military sources now confirm that Chinese warships are en route to the ...
Law And Order: As violent crime waves swamp police across the U.S., the Obama regime plans to dump 6,000 prisoners convicted of drug dealing back on the streets, starting the end of this month. What could go wrong?Don't worry, the Justice Department says, the mass clemency won't hurt public safety. ...
Leadership: From the media's collective hysteria over Rep. Kevin McCarthy's surprise decision to withdraw from running for Speaker of the House, you'd think our system of government had been toppled. Well, it hasn't. Sen. Chuck Schumer of New York warned that the leadership shuffle could lead to a ...
And you get a tax cut! And you get a tax cut! And you, and you, and you! Unless you're poor. Then pay up.So says Bobby Jindal, Louisiana governor, Rhodes scholar and celebrated policy wonk, who through his newly released hack-job of a tax plan has achieved the impossible: He has made Donald Trump ...
The House of Representatives is looking for a new speaker. Such times of change present a perfect opportunity for Congress to reflect on what it should aspire to achieve. On top of the list is getting control of our fiscal situation by restraining government spending in ways that are consistent ...
Investor's Business Daily provides exclusive stock lists, investing data, stock market research, education and the latest financial and business news to help investors make more money in the stock market. All of IBD's products and features are based on the CAN SLIM® Investing System developed by IBD's Founder William J. O'Neil, who identified the seven common characteristics that winning stocks display before making huge price gains. Each letter of CAN SLIM represents one of those traits.


text:
Thanks from a new volunteer
Expand Messages
- Just wanted to drop a qick note of thanks for all the info on this
site. I'm heading over to Gabon on the 26th of this month as an
Environmenatl Education Volunteer with the Peace Corps and am
attempting to gather as much perspective as possible before stage.
If anyone would like to send anything with...I think I remember
reading something about that...let me know and I'll do what I can.
Thanks again,
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subset: commoncrawl


text:
Talk:Rick Barry
|This article must adhere to the biographies of living persons policy, even if it is not a biography, because it contains material about living persons. Contentious material about living persons that is unsourced or poorly sourced must be removed immediately from the article and its talk page, especially if potentially libellous. If such material is repeatedly inserted, or if you have other concerns, please report the issue to this noticeboard. If you are connected to one of the subjects of this article and need help, please see this page.
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I feel strongly that the intro doesn't do credit to Rick Barry's total game, and will try to improve the intro.
Andrew Szanton, 5/06.
Perhaps a picture of him could be provided? —Preceding unsigned comment added by 188.8.131.52 (talk) 08:34, 27 October 2007 (UTC)
Needs a lot of improvement[edit]
Rife with POV, this article looks like a long time fan wrote it. There is a tone to the entire article that tries to be sympathetic to Barry. —Preceding unsigned comment added by A fine point (talk • contribs) 05:25, 29 February 2008 (UTC)
Washington Caps[edit]
The article presently states that Barry "missed the first 32 games before the ABA forced him to join the team." However, it then states that he appeared "in only 52 games due to a knee injury." Since the ABA season was 84 games long, one of these statements is obviously false. Does anyone know the truth? 126.96.36.199 (talk) 00:45, 19 August 2014 (UTC) I know that Barry suffered the knee injury early in the season in a game against the Carolina Cougars in Charlotte. I was not aware that he had missed games that year for any other reason. I know this because I live in Charlotte, and the injury was included in reports of the game the following day in the Charlotte Observer. I do not have access to microfilms of that paper, but somebody who does can confirm this. — Preceding unsigned comment added by 220.127.116.11 (talk) 11:53, 3 June 2015 (UTC)
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Beware of the Size
By jshhlvrsn
from sioux falls, sd
About Me Die Hard Sports Fan, Sports Enthusiast
Best Uses
Comments about Paul Molitor Milwaukee Brewers 1991 #4 Mitchell & Ness Cooperstown Collection Authentic Practice Jersey - Royal Blue:
The jersey is made with quality. I ordered an XL and it is smaller than an XL. I still wear it and like it.
Bottom Line Yes, I would recommend this to a friend
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Sparkfly Photography
On location photography based in the Ballard neighborhood of Seattle, WA.
Send us an email at firstname.lastname@example.com to get started.
Let us know what type of photography you're looking for, the dates (if applicable), and anything else you want us to know. We look forward to hearing from you!


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Westminster News
Local news for Westminster, CA continually updated from thousands of sources on the web.
Erva R. Scherbinske
Monday Oct 5 | The Daily Gazette | Comment?
Westminster creating economic task force
Thursday Oct 1 | The Wave | Comment?
Waiting for a Miracle or Closure, At Least
Wednesday Sep 30 | Patch.com | Comment?
With Powerball jackpot at $301 million, O.C. stores cater to those hoping to strike it rich
Wednesday Sep 30 | The Orange County R... | Comment?
Education reformer turns sights on Santa Ana
Saturday Sep 26 | The Wave | Comment?
Nikes, computer lessons and other cool stuff in this week's best deals
Friday Sep 25 | The Wave | Comment?
American Terrorism: Plain and Simple
terrorism 1,250
How Should the US Government Respond to ISIS?
30 Interracial Celeb Couples You Probably Didn't Know A...
Westminster police searching for missing man who needs medication
Congress, crowds gather to see pope
Thursday Sep 24 | Connecticut Post | Comment?
Activists want official Republic of Vietnam Day throughout the state
Park dedication to longtime leader Margie Rice
Vietnamese refugees reach out to Syrians fleeing by boat
Wednesday Sep 23 | News Times | Comment?
Fire displaces woman, two dogs from Westminster home
Wednesday Sep 23 | The Wave | Comment?
Jilted Man Guilty of Killing of Pregnant Girlfriend
Wednesday Sep 23 | Patch.com | Comment?
McMahon's RV owner faces criminal charges
Tuesday Sep 22 | Anaheim Hills News | Comment?
'Chefs for Scholarships' program celebrates 10th year at Goldenwest College
Monday Sep 21 | Examiner.com | Comment?
Vietnamese political prisoner released, on her way to LAX
Saturday Sep 19 | The Wave | Comment?
Pedestrian killed in Westminster crash identified as 79-year-old man
Saturday Sep 19 | The Wave | Comment?
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text:
Guido is a little Italian forklift and Luigi's assistant and best buddy--you'll hardly ever see the two pals apart. Like Luigi, Guido is an avid Ferrari racing fan who dreams of performing a real pit stop on a real Ferrari.
Watch Clips
See Guido and his pal Luigi race around town in these videos


text:
M. Spencer Green, File, Associated Press
WASHINGTON — Looking for a big-name speaker?
Now may be the time to send President Barack Obama an invitation, especially if your group represents a key political constituency.
Obama has been making the rounds of Washington's awards dinners and black-tie galas this fall, donning a tuxedo or dark suit and heading to ballrooms across the nation's capital to speak to organizations representing blacks, Hispanics, Jews, women and gays. This weekend, he adds Italian- Americans to that list.
With the 2012 campaign picking up steam and Obama struggling to recapture the enthusiasm of 2008, the president's role as headline speaker has plenty of political undertones. He needs the well-connected, politically active leaders of these groups to help him motivate their members, raise money for his re-election and get people to show up to vote in next year's election.
And the president's remarks give him a chance to address specific criticism from some supporters, and tout lesser-known administration actions that target their needs.
Since September, Obama has been the featured speaker at dinners for the Congressional Black Caucus and the Congressional Hispanic Caucus, a forum on American Latino Heritage, and the annual gala for the Human Rights Campaign, a leading gay rights group. The president will speak Saturday at a black-tie dinner for the National Italian American Foundation, and in early November, at an awards dinner for the National Women's Law Center. The liberal Union for Reform Judaism says Obama will speak at its four-day conference in December.
Obama is following the path of many of his predecessors, who have also tried to curry favor with influential Washington-based organizations, particularly those with similar political leanings.
The president has also sent out his own invitations, bringing influential constituencies to the White House for Tribal Nations conferences, for Passover Seders, for Iftars.
With a presidential election just about a year away, the outreach to key voting blocs is more critical than ever. The president's approval ratings have dipped into the mid to low forties amid persistently high unemployment. And with sagging enthusiasm among some core supporters, Obama's campaign could face challenges in getting the first-time voters who helped him win the White House, particularly blacks, Hispanics and young people, back to the polls next November.
White House officials won't say exactly how aides decide which events the president attends. But it's little surprise that Obama rarely finds himself in front of anything less than a supportive audience.
The president often shows up just before he's scheduled to speak, and rarely stays for dinner. His speeches, sometimes delivered before a crowd of thousands, pull from his day-to-day messages on the economy and jobs, but are typically tailored to his audience.
During a fiery speech last month at the annual gala for the Human Rights Campaign, Obama heralded his role in ending the military's ban on openly gay service members and his administration's decision to stop enforcing the Defense of Marriage Act, which defines marriage as between one man and one woman. He also used the opportunity to jab Republican presidential candidates for failing to stand up for a gay service member who was booed by an audience at a GOP debate.
"You want to be commander in chief? You can start by standing up for the men and women who wear the uniform of the United States, even when it's not politically convenient," Obama said.
Rich Galen, a Republican strategist, said Obama would be better served spending more time working with Congress to bring down the nation's 9.1 percent unemployment rate than in trying to boost his political base.
"Doing all of these things is doing nothing to foster any meaningful legislation," he said.
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This Week on Food Network Star's Blogby FN Dish Editor in Shows, August 4th, 2011
The seventh season of Food Network Star is in full swing and the writers on the Star blog are dishing. Last week, the five remaining Food Network Star contestants got roasted by some of the industry's funniest comedians. If you missed the episode, catch up with this recap or watch the latest exit interview. This Sunday, eliminated finalists return to help the final four in head-to-head Iron Chef battles.
- Top 10 Moments from last week's episode
- Melissa's Insight: Listen to Those Judges
- Star Spotlight: Comic Relief
Watch an all-new episode: Sunday, August 7 at 9 p.m. Eastern/ 8 p.m. Central
More posts from FN Dish Editor.
Similar Posts
One-on-One with the Next Eliminated Celebrity Recruit — Worst Cooks in AmericaFind out which celebrity was eliminated in Episode 3 of Worst Cooks in America: Celebrity Edition....
- Being a Judge Doesn't Keep You Safe from the Chopping Block — Chopped After Hours
- The Winner of Food Network Star Dishes on His New Series: "BBQ Blitz Is Something That Best Represents Eddie"
- What Happens When Princess Leia and Dr. Evil Join Forces — Alton's After-Show
- 3 Ways to Do Up Dips for Your Tailgate


text:
Sep 19
Mega Mystery Giveaway
I am giving away five fabulous mystery/thriller books – all signed by their respective authors – plus two bags of Death Wish coffee. You could win the means to be enthralled, frightened, and over-caffeinated all for the price of subscribing to my newsletter! The books are:
Flask of the Drunken Master, the 3rd in Susan Spann's Shinobi Mystery series.
Kilmoon by Lisa Alber, 1st of her County Clare Mysteries
Murder by the Seaside by Julie Anne Lindsey, the 1st of her Patience Price Mystery series
Vacant, the 4th in Alex Hughes' futuristic MIndspace Investigations Series
Study in Death, the 4th in Anna Lee Huber's Lady Darby Mysteries
Giveaway is open to anybody on the newsletter who lives on planet earth and is over 18 years of age. One name will be drawn at random from the list sometime on September 25. If you haven't joined the newsletter yet, you can do that right here and now by clicking HERE. Or not, of course.
Jul 14
New Release: Flask of the Drunken Master
I'm seeing lots of controversy on all my internet feeds today about whether or not to buy a certain book by a beloved author who may or may not have wanted said book to be published.
If you find yourself caught up in this quandary, I have a suggestion for you.
A lot of other books were released today by less famous authors who definitely wanted their work to be published and read. Buy one of those! Make an author happy while you mull the ethical ramifications of buying Harper Lee's discovered manuscript.
One possible suggestion is the new Shinobi Mystery from Susan Spann: Flask of the Drunken Master.
Last I checked, Susan was in full possession of all of her faculties, although a little under the weather from an opportunistic virus that chose to bully her during release week. I can 100% guarantee that she will not object to you buying her book. Here's the cover. Isn't it pretty?
Honestly, as covers go, it's prettier than this, I think:
All you really need to know about Go Set a Watchman is who wrote it. But since the whole world doesn't know and love Susan Spann (yet) here's what Flask of the Drunken Master is all about:
"August 1565: When a rival artisan turns up dead outside Ginjiro's brewery, and all the evidence implicates the brewer, master ninja Hiro Hattori and Portuguese Jesuit Father Mateo must find the killer before the magistrate executes Ginjiro and seizes the brewery, leaving his wife and daughter destitute. A missing merchant, a vicious debt collector, and a female moneylender join Ginjiro and the victim's spendthrift son on the suspect list. But with Kyoto on alert in the wake of the shogun's recent death, a rival shinobi on the prowl, and samurai threatening Hiro and Father Mateo at every turn, Ginjiro's life is not the only one in danger.
Will Hiro and Father Mateo unravel the clues in time to save Ginjiro's life, or will the shadows gathering over Kyoto consume the detectives as well as the brewer?"
So there you have it. You can buy this book at all of the usual places. Here's the amazon link.
And here's the link to Susan's website. Even if you don't feel like buying her book today, you should go look at pictures of sea horses and her trip to Japan. No, the two things have no obvious connection, except for probably in my brain somewhere. They are still excellent and fascinating pictures and worth looking at. There is also more information about the Shinobi Mysteries on this site. And possibly a random penguin or two.
Jul 10
Book Giveaway – Blade of the Samurai by Susan Spann
Listen up, people! The third book in Susan Spann's fabulous Shinobi Mystery series, Flask of the Drunken Master, releases on Tuesday, July 14. In celebration of this momentous event, I'm giving away a copy of the 2nd book, Blade of the Samurai.
Wait. Why am I not giving you a copy of Flask of the Drunken Master when that is the book Susan is launching?
Because I think you should buy a copy, that's why. And also because I happen to have two copies of Blade of the Samurai floating around, so I can give one away and keep one for myself.
Why do I have two copies of Blade?
Damn. You had to ask. I have two copies of Blade of the Samurai because I bought one to do a giveaway for Susan when the book came out. Last year. I've been busy, all right? Don't judge. Especially since you still get a shot at a free book.
As you can see, Frankenpoe is keeping guard until this lovely book can find its new owner.
The Shinobi Mysteries take place in medieval Japan, presided over by an unusual pair of sleuths. First up we have Hiro Hattori, a shinobi (in other words, a highly trained assassin) and Father Mateo, a Portuguese priest committed to bringing the word of God to the Japanese. Mateo likes helping people. Hiro is bound by his code of honor (and, he'll have to admit, some affection) to the task of keeping Mateo alive and well. Murders keep finding them, somehow, and the times are dangerous with rival clans striving for power. Susan knows her medieval Japan and the book is beautifully and authentically atmospheric while providing a taut mystery.
I'm pretty sure that by now your next question is, "How can I win a copy of Blade of the Samurai?"
The rules are simple.
1. Entries accepted only from readers signed up for my newsletter. You can do that here, if you wish. (Hey, you can always unsubscribe later. And I don't spam)
2. You must be 18. I don't know why this is a thing, but I'm told it is. Not because Susan's books are for only 18 and up. They're not.
3. Leave a comment here on the blog.
4. BONUS ENTRY. Answer this question for an extra entry: How do you fill a carp with bees?
Contest open until midnight PST. Yep, it's international.
Apr 9
Books of the Between: Together at Last
My heart is full.
I don't have the words to tell you how deeply satisfying it is to see the physical proof of the completed trilogy lined up on my table where I can drool over them. I owe so much to so many people for helping me to make this dream a reality.
The paperbacks of The Nothing are even more beautiful then I dared to hope. I've ordered in the review copies for my wonderful Kickstarter backers and a few to give away. The fly in all of this marvelous ointment is the realization of how long it apparently will now take for the books to become available on Amazon and Barnes & Noble, etc. Around six weeks, possibly, I'm told.
And yes, if I'd researched ahead of time I would have known this. But I didn't. Because it seems I'm always figuring out life (and publishing) one step at a time as I go along. But hey, where's the adventure when you know what's going to happen next?
Mar 26
New Shiny Nothingness
The cover flats are here!!! This means paper books are on the way soon, soon, soon.!
Mar 24
The Nothing is Here!
The story of The Nothing begins with an OH MY GOD phone call. The kind of call that steals your breath and makes your knees go weak, but in the good way.
I had workshopped Between on the Book Country site and an editor was interested. Would I mind if she read the full?
I didn't mind. And when Penguin acquired the first two books of the Between trilogy I was starry-eyed and elated. Finally! After all of the years of writing and revising and submitting and stacking up rejections, I was about to be a published author. Everything was rose colored and amazing. My optimism knew no bounds. I harbored secret dreams of bestseller status and author tours and all sorts of fun and excitement for my future authorial self.
Things didn't exactly turn out that way. Between launched, followed by Wakeworld. Some readers loved them. A few hated them. But they certainly never went viral and in the end, Penguin opted not to complete the series with the third book, The Nothing.
I will confess to a little spell of self pity and devastation. It crossed my mind (briefly) to stop writing books. But what would I do if I didn't write? I'd become a bitch, that's what. Make that a capital B. Just ask the people who live with me. I have to write. And obviously I was going to complete the trilogy because I couldn't just leave Vivian and Zee and Poe and Weston hanging out in an eternal limbo. So, I got back to work. I'm a writer. I write. And I'm eternally grateful for that. I can't imagine living in a reality where I didn't have words and stories running through my brain.
As it turns out, we live in an amazing world, one in which a book doesn't need a giant publishing house to make its way out into the world. I couldn't stand to leave the trilogy unfinished, so I finished it, and I've launched it out into the world for people to read.
Now, I'm not saying this was easy. The journey through this last book tested me on every level. But growth never happens without pain. I went way out of my comfort zone and did a Kickstarter so I could afford high level editing, and Vikki Ciaffone and Richard Shealy came through brilliantly. The cover, designed by Derek Murphy, exceeded my wildest hopes. And in my own opinion, The Nothing is the best book of the trilogy. I feel good about that.
Today, the ebook version of The Nothing is out on Amazon, Barnes and Noble, and Kobo, with more platforms to come. There will be a paperback, eventually.
And I'm sitting here this morning, swilling my coffee and enjoying a fabulous glow of accomplishment and closure. It feels good to know that I did what I set out to do. I'm indescribably grateful for the opportunity to write books. I'm thankful for the incredibly giving and talented people who have generously helped me along the way. As for the people who read what I write? You complete me. The story is never finished until it's been read.
Mar 19
Look what I picked up yesterday from the post office! I always love new bookmarks, and these are gorgeous. The green color really pops. I'll be giving away a few, along with free books and some other fun prizes at a virtual Facebook launch party for The Nothing on March 24th, from 6 – 9 pm PST. You are invited to swing on by. Here is the link to the event and I hope to see you there.
Mar 17
Sometimes, All You Have To Do Is Ask
Last night a lovely person on my email list alerted me to the fact that the blog was broken. She'd tried to access the page where the free downloads for The Dream Runner are stashed and got a big fat
404 Page not found on server
I tested the link. Yep. I also got the 404. I messed around in the blog for a bit. The page was there. Right there. Looking at me when I went into my dashboard. I could do anything I wanted with it – EXCEPT make it visible. And then, randomly, I clicked one of the other page tabs and got the same damn message. Everything was broken except for the homepage.
Ack! Despair and consternation. What to do, what to do? A brand new shiny website and it was broken. Nobody could read the excerpt of The Nothing. New newsletter subscribers would wonder what they'd signed up for and go away. The whole world was going to fall apart.
Since I didn't really have a clue what to do, I committed what I thought was a desperate act and emailed my blog hosts. Guess what? They emailed right back. And it was fixed within the hour.
I was floored. Really? They're really going to help me with stuff in this quick and painless sort of way?
Yep. So now I feel a little safer. And the blog is up and running. Which is a good thing, with The Nothing coming and all.
I've been noticing this odd trend a lot lately, with the asking for help thing. I don't like to do it and I often don't. Somewhere in my psyche there's a huge sign that reads DO EVERYTHING YOURSELF OR YOU ARE A FAILURE. There's another one right next to it that reads DON'T BOTHER PEOPLE. THEY ARE BUSY.
I think I need to hire a new sign painter. But a lot of helpful people are out there, ready and willing and awesome. And they act as if they like helping. Laura Kreitzer did the interior formatting for the hard copy of The Nothing, for example. Quickly, professionally, painlessly – and out of pure friendship. And she wasn't the first to offer.
When I locked myself out of my website the other day (yeah, I need to be rich and hire a techie person) a Facebook friend who happens to be part of TechSurgeons (these folks are awesome, by the way, offering web services designed for authors) talked me through getting myself back in.
All through my life, there have been times when people popped out of the woodwork offering to help with things. Some of them were good friends. Others were basically strangers. And none of them presented as martyrs or hard done by or any of that ugly stuff. I still find it hard to ask for help, but I'm learning. Maybe I'll ask for a sign painter to make me a brain billboard that reads:


text:
The hard rock bass guitarist and vocalist lives here. He is best known as "The Demon", his blood-spitting, fire-breathing, and tongue-wagging persona in the hard rock band Kiss, an act which he co-founded in the early 1970's. This home was featured on "MTV Cribs" and on the reality series "Family Jewels".
Gene Simmons
Gene Simmons' House
This map's location has been removed for privacy concerns.
By mlc1us @ 2007-04-23 10:25:11
(hidden - privacy request)
Links: en.wikipedia.org
6.7 (190 votes)
Blog Posts
CommentsComments have been disabled for this map
@ 2010-09-17 11:17:59
Absolutely beautiful!!


text:
HIPS In SEPM
I need some basic stuffs regarding HIPS in SEPM
Comments 2 Comments • Jump to latest comment
For starters, check these two articles -
Best practices regarding Intrusion Prevention System technology
Best Practices for employing Intrusion Prevention System (IPS) to high-availability/high bandwidth servers.
Moving thread to Endpoint Protection forum for greater visibility.
It is a signature based rules that get downloaded from internet. However you can create your Custom IPS Rules aswell.
It will protect you against Network based threats/attacks.It is a component that works hand in hand with SEP firewall.
Vikram Kumar
Symantec Consultant
The most helpful part of entire Symantec connect is the Search button..do use it.


text:
Written on: 18/03/2008
Its better then my acer laptop by quite far as far as I am concerned.
It doesn't produce errors like I received with other laptops I have received in the past, this Apple Macbook Pro feels like it is very well made.
Apple Macbook laptops are the best laptops I have so far experienced.
As rated by our community of reviewers
" Good product for sure " Read More
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text:
Ightham Mote
Facilities & access
- Mote Café, serving drinks, snacks, home-cooked lunches and teas.
- Refreshment kiosk open at peak times in walled car park.
- Picnics welcome at the picnic benches near the walled car park and at the north end of the garden beyond the North Lake (not in the formal areas around the house).
- Old Coach House Shop selling a selection of gifts and souvenirs
- Suitable for group visits - please contact us to book
- Toilets and baby changing facilities available behind the Mote Café and Old Coach House Shop.
- Parking for more than 200 vehicles. Please note: this is a Pay and Display car park - National Trust members Free, non-members £2.
- Assistance dogs welcome throughout house and gardens.
- Dogs welcome on the estate - outside the pay perimeter and on the outside patio area at the Mote Café.
- Dog drinking bowls available on Mote Café patio, outside Visitor Reception and the lower gate.
Family & children
- Children's explorer map for the gardens. Available from Visitor Reception.
- Natural play area - imaginative play area for the under 10s.
- Children's quizzes for the house available from the Conservatory.
- Baby-changing facilities in toilets behind the Mote Café and Old Coach House Shop.
- Baby feeding facilities in the main house - please ask a member of staff.
- Baby slings & hip-carry infant seats available to borrow from the Conservatory.
- Buggy friendly route map available from Visitor Reception and the Conservatory.
- Family events and activities throughout the year - please see events page for details or pick up an events leaflet from Visitor Reception.
- Mote Café offers high chairs and a baby bottle and food warming station.
- Designated parking spaces available for disabled visitors in the Walled car par - next to Visitor Reception.
- There is a volunteer-driven shuttle buggy between Visitor Reception and the Shop (depending on availability of drivers).
- For those dependent on motorised mobility chairs, it might be easier to drive down to the disabled entrance next to the shop. Please pay at Visitor Reception first. Please note: some motorised mobility chairs are too large to go round the house due to size / width of rooms and corridors.
- Manual wheelchairs available to borrow from Visitor Reception on a first-come-first-served basis.
- Accessible toilets available at the top of the property, behind the Mote Café; and the Old Coach House Shop near the house at the bottom of the slope.
- Walking sticks / stick seats are available to borrow from Visitor reception on a first-come-first-served basis.
- Gardens have a mixture of gravel and grass paths, some steep slopes, undulating terrain and steps.
- Suggested level access map around the gardens available from Visitor Reception.
- House has uneven floors, steps and doorways of different widths. Only the ground floor is accessible. Please download our access guide for full details.
- Induction loop
- Large print and Braille house guides available to borrow from the Conservatory.
- Assistance dogs welcome throughout house and gardens.
More detailed access guide
As Ightham Mote is a place which dates back nearly 700 years, the house has uneven floors, steps and doorways of different heights and widths. To help you with your visit, we have produced a detailed guide that will help you identify the different 'features' of the house.


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Live From Cannes: Tilda Swinton on 'Only Lovers Left Alive'
4:24 PM PDT 5/26/2013 by THR Staff
Oscar-winning actress Tilda Swinton talks to The Hollywood Reporter about Jim Jarmusch's vampire love story. Of her director, she says: "He is pretty much nocturnal, so the nightscape is pretty much his palette -- which suits me very well, as it happens."
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It's official – the 1999 romantic comedy "The Best Man" will get a sequel.
Universal announced Thursday that Taye Diggs, Terrence Howard, Nia Long, Regina Hill, Morris Chestnut and Harold Perrineau have all signed on to return for "The Best Man 2," to be released on Nov. 15, 2013.
Also returning is director Malcolm D. Lee.
The original followed a writer (Diggs) whose recent autobiography put him at odds with being the Best Man at the wedding of his best friend (Chestnut).
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This Week's Celebrity Instagrams (9/26-10/2)
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Vermonters warned they may be victims of hackers
BURLINGTON More than 1,000 Vermont residents have been warned by a medical records management company that their personal information may have fallen into the hands of Chinese computer hackers.
The Burlington Free Press reported that about 1,100 Vermont residents are being notified that their identifying information may have been stolen.
The data could be in the hands of Chinese hackers behind one of the largest raids on electronic medical records. The notifications were made in an letter Monday from the Tennessee-based Community Health Systems Professional Services Corp.
Its unclear where the affected consumers sought health care. Community Health Systems said it has no affiliation with Vermont doctors or hospitals.MORE IN This Just In
GENEVA — Doctors Without Borders called Wednesday for an independent fact-finding... Full Story
The following is a sampling of calls to Barre Town police in recent days.
Sept. Full Story
NORTHFIELD — Partial service will be restored on Amtrak's Vermonter line today... Full Story
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Traditionally, the use of ketamine for patients with traumatic brain injuries is contraindicated due to the concern of increasing intracranial pressure (ICP). These concerns, however, originated from early studies and case reports that were inadequately controlled and designed. Recently, the concern of using ketamine in these patients has been challenged by a number of published studies demonstrating that the use of ketamine was safe in these patients.
The purpose of this article was to review the current literature in regards to using ketamine in patients with traumatic brain injuries in different clinical settings associated with anesthesia, as well as review the potential mechanisms underlying the neuroprotective effects of ketamine.
Studies examining the use of ketamine for induction, maintenance, and sedation in patients with TBI have had promising results. The use of ketamine in a controlled ventilation setting and in combination with other sedative agents has demonstrated no increase in ICP.
The role of ketamine as a neuroprotective agent in humans remains inconclusive and adequately powered; randomized controlled trials performed in patients undergoing surgery for traumatic brain injury are necessary.
The use of ketamine for patients with traumatic brain injuries (TBIs) and known or suspected intracranial pathology has traditionally been contraindicated due to the possibility of increasing intracranial pressure (ICP). The FDA package insert cautions that "An increase in cerebrospinal fluid pressure has been reported following administration of ketamine hydrochloride. Use with extreme caution in patients with preanesthetic elevated cerebrospinal fluid pressure." Soon after the drug was developed, a limited number of articles were published that reportedly demonstrated that the use of ketamine resulted in increased cerebral blood flow (CBF) and cerebral metabolic rate for O2 (CMRO2), which caused a rise in ICP. Gardner et al. presented data from a series of 11 healthy patients with no pre-existing medical conditions undergoing simple surgical procedures under spinal anesthesia and found that cerebrospinal fluid pressure became markedly elevated after the administration of a standard dose of 2 mg/kg ketamine [1]. In a subsequent case series, the same authors reported that ketamine caused dramatic increases in intracranial pressure in two patients with intracranial masses [2]. Both of these patients were allowed to breathe spontaneously during their brief operative decompressions, and the ketamine anesthesia described consisted of a 2 mg/kg bolus of i.v. ketamine, with no other sedatives or anesthetic agents. Early publications consisted of case reports and small case–control studies that were inadequately controlled and designed.
Recently, this view has been challenged by a number of published studies demonstrating that the use of ketamine was safe in patients with elevated ICP in mechanically ventilated patients or in the presence of background anesthetic agents, resulting in either no significant increases in ICP or even a decrease in ICP and EEG activity. Additional studies have suggested that the use of ketamine may confer neuroprotective effects for patients at risk of ischemic brain injury, reducing cell death and neuronal degeneration. The purpose of this review is to update the current published literature concerning the use of ketamine for patients with brain injuries. Specifically, this review will focus on potential mechanisms underlying the neuroprotective effects of ketamine and its use in the preoperative, intraoperative, and postoperative periods.
Literature searches were conducted with Medline and Embase (1962 to October 2012) using the following search terms: ketamine, traumatic brain injury, intracranial pressure, neuroprotection, induction, and sedation. Following initial review of the abstracts, articles were obtained based on their relevance. References from the identified papers were also examined for further relevant studies. Case reports and letters were not evaluated.
TBI continues to be a leading source of significant neurologic disability, affecting nearly 1.4 million patients each year in the United States. TBI is typically classified into primary and secondary brain injury, with primary injury occurring during the initial insult and believed to be irreversible. Secondary brain injury occurs gradually and is often a result from processes initiated by the trauma. The etiology of secondary brain injury is multifactorial and includes hypoxemia, hypotension, increased ICP, and decreased CBF [3–5].
These secondary injury mechanisms are comprised of several different processes that include an increased inflammatory response, elevated glutamate concentrations, ion imbalances, free radical release, and apoptosis. Elevated levels of glutamate and other excitatory neurotransmitters are associated with certain pathological states, including TBI [6]. The increase in glutamate is thought to be a result of decreased ATP production associated with TBI and ischemia. Glutamate uptake and transporters are dependent on electrochemical ion gradients, which in turn are dependent on ATP. The primary action of ketamine, the noncompetitive inhibition of N-methyl-D-aspartate (NMDA) receptors, is believed to provide neuroprotection through the prevention of stimulation of the excitatory amino acid receptor and a reduction in glutamate excitotoxicity [7]. Excitotoxicity is the process by which neurons are injured through excessive stimulation and has been established as an important process in secondary injury. In addition, excitotoxicity is believed to be involved in a number of other central nervous system pathologies, such as stroke and spinal cord injury. Following increased levels of glutamate and other excitatory neurotransmitters, a high influx of Ca2+ occurs, activating a number of calcium-dependent enzymes that lead to neuronal injury [8]. With increasing levels of calcium within the neuronal cell, proteolytic enzymes are activated leading to apoptosis [9]. In addition to calcium influx, it has been noted that NMDA receptor activation also activates a cAMP response element binding protein shutoff, resulting in the loss of mitochondrial membrane potential and apoptosis [10]. The administration of ketamine resulting in the reduction in glutamate concentrations in the brain has recently been confirmed with the use of magnetic resonance imaging [11].
Another potential mechanism of action of ketamine's neuroprotective properties is its effects on the inflammatory response. Ketamine's antiinflammatory properties are believed to act through its suppression of lipopolysaccharide-induced microglial activation and reducing inflammatory cytokines such as tumor necrosis factor and IL-6 [12]. Elevated plasma concentrations of IL-6 have been investigated as markers of prognosis and infectious complications in patients with brain injuries [13]. Although there have been no human studies that have examined plasma concentrations of inflammatory markers in TBI patients following the administration of ketamine, Bhutta et al. examined the effects of ketamine and its noninflammatory properties in association with patients undergoing cardiopulmonary bypass [11]. The study randomized 24 infants to receive ketamine or placebo before cardiopulmonary bypass. Based on plasma inflammatory markers collected at different time intervals, no significant differences were observed.
The use of ketamine for unstable patients has long been advocated due to its enhancement of a centrally mediated sympathetic response and maintenance of hemodynamic stability. This is of particular importance in the setting of TBI, where hemodynamic instability should be avoided. Hypotension can be the result of blood loss in the field or sedating medications and can be caused by an isolated head injury [14]. Numerous studies have demonstrated that hypotension is a major predictor of outcomes in patients with TBI [15–18]. Compared with patients without hypotension, even a single episode of hypotension has been associated with worsening secondary brain injury and increased morbidity and mortality [15,19]. Manley et al. found that 2 or more hypotensive episodes in patients presenting with a Glasgow Coma Score (GCS) <13 increased the relative risk of mortality to 8.1 (95% CI 1.63–39.9) [20]. Activation of the sympathetic nervous system with the administration of ketamine can result in maintaining cerebral perfusion pressure (CPP) for patients with TBI. Certainly, either an isolated decrease in MAP or an isolated increase in ICP or a combination of the two can negatively affect CPP and potentially cause brain ischemia. Struchen et al. followed a cohort of 184 brain injured patients in the neurosurgical ICU and found that a CPP <60 mm Hg was associated with worse outcomes [21]. Schmittner et al. demonstrated that the need for vasopressors when using ketamine for sedation in comparison with fentanyl is decreased [22].
Recent studies have examined the effects that ketamine has on spreading depolarizations [23,24]. Spreading depolarizations are described as propagating waves of neuronal and glial depolarizations. Under normal conditions in an intact central nervous system, these depolarizations result in depression of neuronal activity. However, in patients with TBI who already have a depressed neuronal activity, these depolarizations cannot cause further depression. Under these circumstances, they result in further neuronal injury and are associated with poorer neurological outcome. When measuring electrocorticographic recordings with the administration of ketamine, a sustained inhibition of spreading depolarizations was observed. This finding suggests another potential mechanism underlying ketamine's use as a neuroprotective agent.
When the decision has been made to intubate the patient with a suspected or known head injury, the chosen induction agent should provide optimum intubating conditions and minimize secondary brain injury. Ketamine in combination with a neuromuscular blocking agent like succinylcholine provides amnesia and analgesia during intubation and has been shown to yield similar success rates when used by emergency personnel for prehospital and presurgical intubation [25,26]. The wide availability of ketamine, its affordability, and provision of advantageous intubating conditions make it a suitable choice for induction when aspiration is a risk.
Early studies on ketamine as an induction agent for neurosurgical procedures concluded that it was an inappropriate agent for any patient with increased ICP. Wyte et al. described two cases in which ketamine was used as the induction agent [27]. The first patient had a known, pre-existing elevated ICP and had a significant increase in ICP following ketamine administration. The second patient did not have intracranial hypertension and had only mild fluctuations in ICP following ketamine. Of note, both patients were allowed to spontaneously breathe after induction with ketamine. When controlled ventilation was initiated in the first patient, ICP decreased precipitously. Belopavlovic et al. studied the effect of two induction drug combinations on the ICP of patients undergoing neurosurgical procedures [28]. One group received midazolam (0.15 mg/kg) followed by ketamine 1 mg/kg, and the other group received diazepam (0.2 mg/kg) followed by ketamine (1 mg/kg). They concluded that the combination of midazolam and ketamine cannot be recommended for induction in neurosurgical patients due to a critically reduced CPP. Although not extensively discussed in the article, the calculated CPP following the initial midazolam dose decreased in 8 of 10 patients. After the subsequent ketamine dose, the calculated CPP improved in 5 of 10 patients, declined an average of 15.65% (range 5–18%) in 4 patients, and was unchanged from baseline in one patient. In the setting of head injury, an induction including a large dose of midazolam is difficult to justify, making the results of this study not applicable to the question of whether ketamine can be safely used for induction in head injury patients.
More recent studies call into question the assertion that ketamine is an inappropriate induction drug for brain injury patients. Jabre et al. conducted a randomized controlled single-blind trial on 655 patients who required sedation for emergency intubation [29]. Patients were randomly assigned to receive either etomidate (0.3 mg/kg) or ketamine (2 mg/kg) for intubation. Sixty-nine percent of the patients in each group were intubated due to coma. The final diagnosis was trauma in 24% of the etomidate group and 20% of the ketamine group. The study does not present the number of patients with a diagnosis of head injury. They found no difference between the groups in terms of sequential organ failure assessment (SOFA), difficulty of intubation, early complications after intubation, 28-day mortality, catecholamine-free days, duration of weaning from the ventilator, and length of stay in the ICU. There were no serious adverse events with either study drug. Smischney et al. conducted a randomized, double-blind, placebo-controlled trial comparing induction and intubation with propofol to induction and intubation with a mixture of propofol and ketamine (ketofol) as an induction "cocktail" in ASA I and II patients [30]. They concluded that ketofol provided better hemodynamic stability than propofol in the 10 min following induction. Recent drug shortages in the United States have affected the availability of a variety of medications including thiopental, propofol, etomidate, and succinylcholine. Although many anesthesiologists would choose etomidate as a first-line induction medication for traumatically injured patients because of its association with hemodynamic stability, drug shortages have often forced them to choose an alternative medication. Given the previously established goal of maintaining both SBP and CPP, ketamine may very well have a role as an induction agent for brain injury patients. In catecholamine-depleted patients or in patients who lack autonomic control, ketamine's myocardial depressant effects may predominate [31,32]. However, acutely injured patients are not catecholamine depleted and ketamine is likely to result in a rise in heart rate (HR), SBP, and cardiac index (CI) [33]. In hypotensive or hypovolemic patients who have a head injury, induction of ketamine may improve hemodynamics, including SBP and CPP.
Growing evidence demonstrates that the intraoperative use of ketamine appears to be a promising addition in the anesthesiologist's formulary. Ketamine has shown neuroprotective effects against ischemic brain injury and glutamate-induced brain injury in rodent models, and its intraoperative administration might also allow the use of lower concentrations of potent volatile anesthetics, thereby minimizing cerebral vasodilation [34]. Because other intravenous anesthetics (such as propofol, thiopental, and etomidate) reduce cerebral blood flow, intracranial pressure, and CMRO2, administration of these agents might more rationally be expected to provide optimal operating conditions and a metabolically quiescent, slack brain, these agents would seem to be more rational choices for intraoperative administration in cases of neurotrauma.
Unfortunately, no high-quality trials have been performed to date on the intraoperative use of ketamine for neurotrauma. The limited human data that exist are either retrospective multicenter reports or reports on the use of intraoperative ketamine during craniotomies for indications other than TBI. No randomized, controlled trials have been performed directly addressing this area of substantial clinical uncertainty.
Mayberg et al. studied the cerebral hemodynamic effects of ketamine on 20 patients undergoing craniotomy for intracranial tumor or aneurysm [35]. After thiopental induction, endotracheal intubation, and institution of positive pressure ventilation, anesthesia was maintained with isoflurane and nitrous oxide in oxygen. Subsequent intraoperative administration of intravenous ketamine 1 mg/kg reduced intracranial pressure from 16 ± 1 mmHg to 14 ± 1 mmHg (P < 0.001) and likewise reduced middle cerebral artery blood velocity from 44 ± 4 cm/s to 39 ± 4 cm/s (P < 0.001).
Grathwohl et al. performed a retrospective review of all patients admitted to a US military Combat Support Hospital for operative treatment of TBI [36]. Of 214 patients meeting inclusion criteria over a 15-month period, 94 received total intravenous anesthesia, of whom 47 received ketamine and 47 did not. Modified propensity score analysis and matching on injury severity and other variables were performed to eliminate possible sources of bias. No difference in mortality was found, nor was there any difference in neurosurgical outcome: Glasgow Outcome Score (GOS) was 4 (4–5) in the ketamine group, versus 4 (3–5) in the no-ketamine group (P = 1.0), with no difference in the proportion of patients achieving a good outcome (GOS 4 or 5).
Hertle et al. conducted an exploratory retrospective multicenter study of 115 patients undergoing craniotomy for neurotrauma, subarachnoid hemorrhage, or malignant stroke during the course of which electrode strips were placed on the surface of the affected cortex [23]. These patients received a variety of anesthetic regimens, as no standard regimen had been prescribed prospectively. Spreading waves of cerebral depolarization, thought to be indicative of neuronal swelling due to the breakdown of ion transport across cell membranes, were observed in 76 patients. 26 of these 76 patients received ketamine (median total dose 200 mg) at some point during their stay in the intensive care unit, with administration of ketamine peaking on the seventh day after injury. Of the variety of sedative agents administered while electroencephalograms were being recorded, ketamine was linked with a reduction in the frequency of spreading depolarizations and in the frequency of temporally associated spreading depolarization clusters. The clinical significance of this observation is unclear, as no other outcomes such as GOS or death were recorded. As a cautionary note, in contrast to this latter finding, of 7 anesthetic/sedative agents given after controlled cortical impact in rats, ketamine 10 mg/kg i.v produced the greatest degree of hippocampal neuronal death, whereas isoflurane produced the greatest degree of hippocampal neuronal survival [37].
The goal of sedation in critically ill patients with TBI is to produce anxiolysis, prevent agitation, and facilitate manipulation of mechanical ventilation [38]. The gold standard for monitoring sedation in these patients is the neurologic examination. The choice of sedative agent can often obscure pertinent clinical findings. The confusion and agitation that accompany brain injury increase brain metabolism and precipitate struggling and resistance to nursing care and mechanical ventilation [39]. An important objective in this group of patients is to maintain adequate cerebral perfusion pressure. This can be accomplished by maintaining adequate mean arterial pressure, blood gases, body temperature, serum glucose concentration, electrolytes, and osmolarity.
Agents used for sedation of TBI patients are similar to those used for other critically ill patients. They include benzodiazepines, opioids, clonidine, dexmedetomidine, propofol, etomidate, and ketamine. Selection of shorter-acting agents may have the advantage of allowing a brief interruption of sedation to evaluate neurologic status [40]. The agents can be used on their own or in combination in order to achieve adequate levels of sedation for mechanically ventilated patients while maintaining stable hemodynamics. A systematic review of all agents by Roberts et al. found no evidence that one agent is more effective than the others in improving neurologic outcome or mortality of critically ill adults with TBI [38]. They did find that boluses and short infusions of opioids resulted in clinically and statistically significant increases in intracranial pressure and decreases in mean arterial pressure and cerebral perfusion pressure compared with baseline in three trials [41–43].
Historically, ketamine has not been used to provide sedation in patients with TBI due to the risk of increasing intracranial pressure in this group of patients. Ketamine antagonizes excitatory amino acids at the NMDA receptor and may reduce the consequent calcium ion mobilization and neuronal damage that occurs in head injury [44]. However, it has not gained widespread use as a sedative agent in TBI patients due to reported detrimental effects on cerebral blood flow, CMRO2, and intracranial pressure [45]. Another potential disadvantage is the reduction in seizure threshold [46]. There are four studies that specifically address the issue of ketamine sedation for patients after TBI. The first study conducted by Albanese et al. involved 8 patients with TBI [47]. These patients were sedated with propofol infusion at 3 mg/kg/h, had neuromuscular blockade with vecuronium bromide at 9 mg/h, and had PaCO2 maintained between 35 and 38 mm Hg. Ketamine was added to the sedation regimen at doses of 1.5, 3, and 5 mg/kg given in 6-h intervals in order to gauge its effects on intracranial pressure, cerebral perfusion pressure, jugular vein bulb oxygen saturation, middle cerebral artery blood flow velocity, and electroencephalogram. The researchers found no statistically significant difference in heart rate, mean arterial pressure, and cerebral perfusion pressure at any of the ketamine doses given when compared with baseline. Of interest, intracranial pressure in this study decreased between 18 and 30% depending on the dose of ketamine given. This contradicts the common assumption that ketamine increases intracranial pressure.
A study by Kolenda et al. prospectively allocated 35 TBI patients to sedation with ketamine and midazolam or fentanyl and midazolam [48]. In the study, the average dose of ketamine required for adequate sedation was 104 mg/kg/day compared with 100 µg/kg/day of fentanyl. The average midazolam dose was comparable between the groups with an average of 11.1 mg/kg/day for the ketamine group and 10.7 mg/kg/day for the control group. Although the average intracranial pressure in the ketamine group was 2 mm Hg higher, the cerebral perfusion pressure was also improved at 8 mm Hg higher due to an increase in mean arterial pressure of 10 mm Hg. In addition, the researchers reported improved tolerance to tube feeding in the ketamine sedation group, although this was not a primary outcome.
Bourgoin et al. performed two prospective, randomized trials studying ketamine for sedation in patients with TBI. The first study compared sedation with ketamine and midazolam to sedation with sufentanil and midazolam in 25 patients with TBI under controlled mechanical ventilation [49]. Patient in the study had a starting Glasgow Coma Scale score ranging from 3 to 8. The goal of sedation in this study was to obtain a quiet patient with an intracranial pressure less than 25 mm Hg and cerebral perfusion pressure greater than 70 mm Hg. Average infusion rates used were 82 ± 25 µg/kg/min of ketamine and 1.64 ± 0.5 µg/kg/min of midazolam in the ketamine group compared with 0.008 ± 0.002 µg/kg/min of sufentanil and 1.63 ± 0.37 µg/kg/min of midazolam in the sufentanil group. Sedation efficacy was assessed during endotracheal suctioning of these patients. The researchers found no significant differences in the mean daily values of intracranial pressure and cerebral perfusion pressures. Patients in the ketamine group did have a longer recovery time after the infusion was stopped when compared with sufentanil. Both patient groups showed the same tolerance to enteral nutrition.
The second study by Bourgoin et al. looked at the effects of a target-controlled infusion of sufentanil and ketamine on cerebral hemodynamics [50]. Thirty patients with TBI and Glasgow Coma Scale less than 9 were enrolled in the study and randomized to one of the groups. Sedation was initiated with a target plasma concentration of 0.3 ng/ml sufentanil and 100 ng/ml midazolam in the sufentanil group and 1 µg/ml ketamine and 100 ng/ml midazolam in the ketamine group. Mean arterial pressure, cerebral perfusion pressure, intracranial pressure, and mean velocity of middle cerebral artery flow were continuously measured, and PaCO2 was maintained between 35 and 38 mm Hg throughout. Twenty-four hours after the initiation of sedation, target plasma concentrations of sufentanil or ketamine were doubled. Initial values for intracranial pressure and cerebral perfusion pressure, as well as the values after doubling the concentrations of both agents, were not statistically different between the groups. The twofold increase in sufentanil or ketamine concentrations did not involve significant change in mean arterial pressure, intracranial pressure, and cerebral perfusion pressure compared with the baseline values.
The studies described above report no increase in intracranial pressure of TBI patients receiving ketamine for sedation when ventilation is controlled or when midazolam was given concurrently. Potential advantages of ketamine administration compared with opioids are maintenance of hemodynamics and cerebral perfusion pressure, better tolerance of enteral nutrition, and absence of withdrawal symptoms [49]. However, the total number of patients studied to date is insufficient to make any conclusions as to whether ketamine in addition to other agents, or by itself, should be used routinely for sedation of TBI patients. These data suggest that ketamine should be considered as an adjunct for sedation, especially in patients where hypotension is a major problem. It does not appear to adversely affect intracranial pressure in the setting of controlled mechanical ventilation. Future well-controlled, randomized controlled trials are needed in order to determine whether ketamine should become a common sedation agent in TBI (Table 1).
In conclusion, while there are promising signs that the use of ketamine during TBI procedures may increase in the future, the data are too sparse to provide firm guidance at this time. As discussed, studies examining the use of ketamine for induction, maintenance, and sedation in patients with TBI have had promising results. The use of ketamine in a controlled ventilation setting and in combination with other sedative agents has demonstrated no increase in ICP, which is the major concern of anesthesiologists regarding ketamine for patients with TBI. However, the role of ketamine as a neuroprotective agent in humans remains inconclusive and adequately powered, randomized controlled trials performed in patients undergoing surgery for TBI are necessary.
This work was supported with resources and the use of facilities at the Michael E. Debakey VA Medical Center, Houston, TX. Dr. Mathew has received funding support from NIH/NIMH grant RO1MH081870, NARSAD Independent Investigator Award, and The Brown Foundation, Inc. In the past 2 years, Dr. Mathew has served as a consultant or received grant/research support from the following pharmaceutical companies: Allergan, AstraZeneca, Bristol-Myers Squibb, Cephalon, Inc; Corcept, Johnson & Johnson, Noven, Roche, Takeda.
The authors have not published or submitted the manuscript elsewhere. None of the authors have any financial interests to disclose in the information contained in the manuscript.
Publisher's Disclaimer: Disclaimer
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's Canada Institute for Scientific and Technical Information in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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RUNES Middleware
RUNES is a cross-platform, component-based middleware framework allowing for dynamic reconfiguration of functionality. Its lightweight implementation spans powerful nodes like PDAs and PCs, as well as tiny embedded devices.1 weekly downloads
This is a component for the Heimdall sensor fusion middleware. It uses the civic addresses, like the ones returned by the revgeo_fireeagle and revgeo_google components and combines them in order to get a more detailed/accurate result.1 weekly downloads


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Get your vintage fix from amongst thousands of classic items of clothing & accessories on Oxfam's Online Shop. For more from Oxfam Vintage why not visit our Vintage page for tips on looking after your vintage clothing, the Oxfam vintage blog, and more!
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Shirley Ardener
1 portrait of Shirley Ardener
© Samuel Finlak / Joseph Chila / David Zeitlyn
Shirley Ardener
by Samuel Finlak, and by Joseph Chila
bromide fibre print, June 2005
11 in. x 15 in. (279 mm x 380 mm) image size
Purchased, 2007
Photographs Collection
NPG x128891
Click on the links below to find out more:
Sitterback to top
- Shirley Ardener, Social anthropologist. Sitter in 1 portrait.
Artistsback to top
- Joseph Chila (1948-). Artist associated with 2 portraits.
- Samuel Finlak (1958-). Artist associated with 2 portraits.
Subjects & Themesback to top
Tell us moreback to top
Can you tell us more about this portrait? Spotted an error, something missing, or do you know anything that we don't know? If you have any information to share please complete the form below


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Top 10 Addiction Medicine Specialists in Davis, CAWhat is a Addiction Medicine Specialist?
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iLuv IEP315BLK 3.5mm Connector iPhone Earphones with Remote - Refurbished for Free | IEP315BLK | IEP315 | 639247132528
| | Android App | eCouponsinfo | Newsletter | Submit Deal | Feedback | | Compare Price | Blog | Other Sites
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The above deal was published on 2013-06-25. Please note that the Past deals may or maynot be valid! The past deals may have expired or deals may have changed since published. Please check the validity of the deals at merchant site before participating in the deal. This feature is provided for reference purposes only! Please check the main page for the latest deals!DescriptionThe iEP315 In-ear earphones with iPod microphone remote allow you to control both your iPod and iPhone functions. These earphones also provide hands-free calling and voice memo recording options via the built-in microphone.Price History
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Tagged as: IEP315BLK | IEP315 | 639247132528 | Home Electronic Headphone


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Montmartre and Sacre Coeur Walking Tour in Paris
Read what other Viator.com travelers think about the Montmartre and Sacre Coeur Walking Tour in Paris. What they loved, what they liked and what they think could be improved, it's all here to help you make the most of your next trip.
Click here for tour details, schedule and pricing
This tour is the best way to highlight the hidden side of the Montmartre that sadly on your would be missed. Gill our guide was just fantastic with an obvious passion and enthusiasm for the area and made the tour both interesting and fun. A tour not to be missed.
Our guide was Gill and he was so great! He was super smart, kept a perfect pace for our group and was very kind and considerate. He made my first venture to Montmartre a perfect day!
Enjoyed the walking tour of Montmartre....very interesting and educational...Lots to see...Would allow time before or after to visit great eating cafes/restaurants...Great atmosphere.
brilliant guide with only 3 of us on the tour which was great, we must of explored every inch of Montmarte it was such an interesting and such a pretty area with the vineyards hidden away!! and the windmills lovely lovely tour could not of done what we did without a guide with his knowledge and enthusiasm
do not miss it totally brilliant afternoon
This was a great walking tour,gill our tour guide was very informative. The pace was perfect for everyone and we discovered a lot of hidden gems we would never have found on our own. Thank you.
This was a wonderful tour! Our guides were so personable, and knowledgeable of the area. Just bear in mind that you will be doing lots and lots of uphill walking on cobblestone streets. Basically, the tour was an overview, and because we were staying right in Monmartre we were able to come back on another day and visit the Church of San Pierre ( which is the oldest church in Paris) as well as other areas where we were taken. The Church of San Pierre is not to be missed. So so much history within those quiet walls!
Silly people! Don't judge on first impressions/ appearances. Steph has an amazing amount of informative interesting knowledge presented superbly. The tour never lagged and we still wanted more after 2 1/2 hours.
We have 4 more tours booked and would book Steph for all if we could.
Steph is a very pleasant, knowledgeable and most important PASSIONATE tour guide. i love her so much. She knows Montmartre inside out, not only telling us about the historical aspect, but the way she brought us to deeper philosophical view on Montmartre.
I really enjoy the way she lift our moods by her witty point of view. She is refreshing :)
AWSOME and one of the best tours we attended. The guide was outstanding. A great way to start the trip.
Unfortunately, had to miss this tour
Vsevolod B
Exelent, superb, knowledgeble, smart, funny guide who did all his not easy job with love.
We loved the walking tour of Montmatre, our guide Stephanie was incredibly good at her job and spoke loud and clear which for my Mother who is deaf in one ear was fantastic, first time we've been on a tour and I've not had to repeat everything that was said! Reaching the Sacre Couer was well worth all the walking!
We loved this tour! Our guide was very informative and interesting. We saw things (a small cemetery, van Gogh's home exterior, street art tucked away, the local vineyard, etc.) that we wouldn't have seen or appreciated if we had done this walk on our own. Well worth the price and time!
Kit was a fantastic, informative guide! He brought Montmartre alive! Truly a fantastic tour. We had never been to Paris before and this tour was a perfect way to spend the afternoon.
South Africa
Absolutely the best way to discover Montmartre!
Very interesting and informative!
Excellent small group walking tour that took us from the base of Montmarte to Sacre Coeur. Our guide was well prepared as he led us from the Moulin Rouge, to the cemetary and past the homes of many of the Impressionists. He told it in a very personal way which made it even mor einteresting.
Unfortunately, we missed the walking tour, as we were not aware of the daylight saving changeover. We left the arranged area after waiting for about 20 minutes, thinking that there was a no show. Nevertheless, we did the Montmatre and Sacre Coeur walk ourselves and it is indeed somethng not to miss. Suggest the tour though instead. .
I had not used Viator before but would certainly us of again. The tour guide we had was incredible. Not only did he have a great knowledge of the history of the area but was also an artist so he shared so much information about the artists who inhabited buildings in the area.We saw Moulin Rouge,Moulin de la Galette,cemetery,Sacre Coeur,Au Lapin Agile contrasting parts of Montmartre.The tour lasted 6 hrs. and we were physically and emotionally exhausted but learned so much. The guide was also helpful in helping us find our way home at the end of the tour. This was my best day in Paris.
Fat Tire are one of the best tour operators I've come across in Europe. Previously I had tried their biking tours and this was my first walking tour. Jim was very fun, informative and just good company while walking around Montmartre. Recommend this tour to anyone wantign to explore Paris. This is a way better idea than just going up to Sacre Couer for the obligatory picture.
This was an amazing walking tour. The guide was an English speaker and shared with us all the history of Montmarte. Because it was raining, our group was only 5 people which gave us a better experience and the ability to ask questions. Montmarte was such an influential part of the history of Paris, as was its impact on the art world. My only slightly negative take away was that we ended up at the Sacre Coeur and it wasn't really part of the tour. C'est la vie- it is free to enter Sacre Coeur, and only 8 Euros to go down into the Catacombs. I had arrived early and gone into the church, as well as the Musee de Montmarte (highly recommended), so all in all it was a perfect 2 hours.
Our tour with Kit was excellent. He gave us a perfect blend of history, culture, background stories, and the "life" of Montmartre. One caution: this tour does require a lot of strenuous walking uphill.
Very informative
I'm so glad I decided to book this walking tour - there's no way I would have 'discovered' most of the things our guide so expertly shared with us. She told us the stories behind the famous buildings and landmarks and made the experience truly special. Thank you!
Very good, good guide with Parisian ideas !


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Jenni trains all levels of Dressage horses from Intro to FEI. She is a USDF Certified Instructor to second level and is a â��Lâ�� graduate with distinction…
We are a horse/cattle/poultry farm in lovely middle Tennessee. We also offer veterinary reproductive services and sell horse and cattle hay!
Gaited Mules for show and the Trail.
Standing at Stud premier Gypsy Cob stallions. Romeo, Clononeen Dalcassian; Taskin; and Villa Vanner's Silver Bullet
We are just a small farm and do not operate as a buisness.We do have TWBEA's Secret's Sky Hi by WGC The Skywatch, standing at stud.We occasionally…
Offer shoeing, teethwork, boarding and sales prep. Also standing 2 Spotted stallions.
Horses and colts for sale, breaking and training.
breeding and training... we also are interested in buying running blood horses


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Biona Organic Lentils Vert 400g
32.3p per 100g
Product Description
No Added Sugar or Salt
Drained Weight: 235g.
Product Information
Food Cupboard/
Tins & Cans/
Beans & Pulses/
Food Cupboard/
Tins & Cans/
Food Cupboard/
Tins & Cans
- Brands: Biona
- Dietary & Lifestyle: Organic, Vegetarian
Biona Organic
Store in a cool dry place. Once opened transfer contents to a suitable container, refrigerate and treat as fresh food.
Country of Origin
34A Clifton Rd,
Package Type
Recycling Information
Recyclable steel
Lentils Vert*, Water, *= Certified Organic Ingredients
Dietary Information
No Added Sugar; No Added Salt; Organic
Nutritional Data
|Typical Values
|per 100g drained
Customer Reviews
05 August 2015
green lentils
Contrary to what people said, they are green lentils. They are delicious, cold in salad, With olive oil and balsamic vinegar, salt, pepper and thyme, or hot with cooked carrots, onions and potatoes. So quick too as the dry ones take ages to cook.
19 March 2013
1 of 1 found this review helpful.
Green lentils? Brown!
Not what I expected. They are brown lentils, not green. Contacted Biona who were to look into it but not heard back from them. Apparently they could be brown Puy lentils!
03 March 2010
2 of 3 found this review helpful.
watch out ! wrong product
I ordered this product a few weeks ago as my husband likes Puy lentils. Unfortunately we got delivered the wrong product: green lentils instead. Very disappointed, I ordered it a second time and got delivered... the wrong product again ! I guess the labeling is faulty, in any case I complained twice and I do not dare now to order it again as I already have two cans of green lentils that I don't know what to do with !
Chickpea, Cheddar and Onion Burgers
Guilt-free fast food! Perfect in a toasted bun, these deliciously spicy burgers will become firm favorites and are guaranteed to convert even the most committed of carnivores.
22 mins
This delicious dhal can be served as either a thick curried stew dish with rice or as starter with naan bread. Or transform it into a soup by adding an extra half pint of coconut milk.
45 mins
Lentil and Bean Salad with Feta
This salad is just as delicious the day after prepared, so a great idea for a packed lunch or lunch 'on the go'.
30 mins
- Disclaimer
- These summary details have been prepared for information purposes only, and are designed to enhance your shopping experience on the Ocado website. While we have taken care in preparing this summary and believe it is accurate, it is not a substitute for your reading the product packaging and label prior to use. You should note that products and their ingredients are subject to change. If you do require precise ingredient information you should consult the manufacturer, whose contact details will appear on the packaging or label.
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- This data is supplied for personal use only. It may not be reproduced in any way whatsoever without Ocado Limited's prior consent, nor without due acknowledgement.


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Lanvin's quilted leather shoulder bag is a clean and chic style you can work for day or night. This medium-sized design has three internal compartments and a front zip pocket to keep your essentials neatly organized. Carry it against a monochrome top and a slim pencil skirt.
Black leather (Lamb)Magnetic-fastening front flap
Product code: 456416 - Need help? Contact us


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Conservation science never sleeps! And sometimes conservation scientists don't either. What is it like to run experiments during the graveyard shift? More»
The Queen Who Wasn't
Louis XIV clandestinely wed his mistress, Madame de Maintenon, at Versailles on October 9 or 10, 1683. The marriage was much gossiped about but never openly acknowledged. She was never queen.
Madame de Maintenon had been the {judgy} governess to Louis XIV's children by his previous mistress, Madame de Montespan. Louis gave these children moneyed titles—such as the comte de Toulouse, who ordered the tapestries shown here for his residence outside Paris.
Louis's secret marriage ushered in a period of religious fervor, in sharp contrast to the light-hearted character of his early reign. Madame de Maintenon was known for her Catholic piety, and founded a school for the education of impoverished noble girls at Saint-Cyr in 1686 that stayed in operation until 1793. This engraving of the Virgin and Child was dedicated to her by the king.
Virgin and Child, late 1600s, Jean-Louis Roullet after Pierre Mignard; Johann Ulrich Stapf, engraver. The Getty Research Institute. Tapestries from the Emperor of China series. The J. Paul Getty Museum


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Do You Contribute To and Use Wikipedia?
Like us on Facebook
I find the results shocking. Next to Google, Dictionary.com and IMDB, Wikipedia has long been my go-to source for trivia and back story (taken with a grain of salt, naturally), but I have never contributed an entry. How about you?


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Im wanting to delete posts in my wordpress multisite via mysql database.
I know the querie to use but I want to skip a few sites so that they delete any posts in them.
What do I modify or add in this code?
DELETE FROM wp_posts WHERE post_date < '2010-01-01 19:18:00' AND post_status = 'publish'
my multisite sites are split like this wp_2_posts,wp_3_posts etc etc.


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This location is shown only to members
Free and open to the public. We will divide our time between generative writing exercises provided by a facilitator, and workshop sessions for writers seeking revision suggestions. To participate, RSVP so we know how many people to expect (we will cap the group at 10), and, if receiving feedback, email work in advance to the group, using the googlegroup below.
When: every other Monday night, 7-9 pm
Where: Doyle's Café (Jamaica Plain)
About the moderators:
Rachel Becker has an M.Phil in Early English literature and is a published poet and fiction writer whose work has appeared in The Exquisite Corpse (ed. Andrei Codrescu), and Notes from Underground: A Literary Lab Anthology. She teaches English and writing in Newton.
Celeste Bocchicchio-Chaudhri is a writer, artist, and milliner. Her writing has been included in chapbooks produced by the Poet's League of Greater Cleveland. She has collaborated on and contributed to many zines including zine Galatea's Pants, Seeking the Lotus, and Our Country: The Vagina Monologues Zine.
I started the group because there wasn't any other type of group like this. I've met some great folks in the group who have become close friends and have also met some amazing business owners.
— Bill, started New York City Gay Craft Beer Lovers
Meetup members, Log in
By clicking "Sign up" or "Sign up using Facebook", you confirm that you accept our Terms of Service & Privacy Policy


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A Fremont Democrat is making a second run for the U.S. Senate.
Larry Marvin announced he is seeking his party's nomination in a press release that was issued Wednesday.
"The important of Larry's candidacy is that we have choice and competition," he said in the press release.
Marvin ran for Senate in 2008, finishing fourth in the Democratic primary with about 3 percent of the vote.
Democratic Sen. Ben Nelson is likely to seek re-election, but a final decision is not expected until later this year.
Nebraska Attorney General Jon Bruning, State Treasurer Don Stenberg and Schuyler investment adviser Pat Flynn are seeking the Republican nomination.
Marvin was born and raised in Nebraska and served in the U.S. Air Force. He said he is a property taxpayer in Brown, Cuming and Dodge counties.
He has been active in the Democratic party for more than 40 years.


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uhilu participated with 20 other designers who submitted 84 entries and was awarded $200. View this project »
yes great. thanks. sboc
Name your own price, then watch as dozens of participants submit ideas and choose your favorite. Our 100% money-back guarantee makes it risk-free!
Let us match you up with one of our very best Creatives and work 1-to-1 in complete privacy. You'll have all of the same tools and features as our regular projects!


text: I had a lovely stay in this Riad. The staff are very friendly and kind. It is in an excellent location to explore Marrakech, although the location was tricky to find without a friendly 'guide' (you'll find lots of local friendly 'guides' trying to help you find places during your time!). I was grateful in the end to my 'guide'... More


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Pedestrian struck by vehicle in North Portland
A woman struck by a vehicle in North Portland Wednesday night remains in critical but stable condition.
A woman struck by a vehicle in North Portland Wednesday night remains in critical but stable condition.
A local veteran's delayed medical treatment at Portland's Veteran Affairs Medical Center mirrors concerns at VA hospitals across the country…
Electronics stolen from a local man first posted on his own Facebook page after suspects hacked it were also listed on Craigslist.
Beaverton police have found an 84-year-old woman who was reported missing Wednesday.
More than 25 firefighters responded to a fire at a home in Silverton Wednesday afternoon.
Oregon Iron Works and Vigor Industrial announced the companies are joining forces on Wednesday.
Evergreen Public Schools says a school bus driver accused by parents of forcing children to ride in a sweltering bus has resigned.
A Marion County Grand Jury unanimously found that a Salem police officer was justified in his use of lethal force against Jacklynn Ford.
Oregon winegrowers are fighting back against a certain type of herbicide that they say is hurting their crops.
Wildlife officials said they're stumped on how to cure the elk hoof rot disease.


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Black Barbarian Studs Jerks Off in Costume
The following tags exist in this scene. You can find similar scenes by combining tags in this scene together using the checkboxes, or just click a tag name to browse...
Starring knight Stick, DVD: Gladiators School
Do you recognise pornstars in this scene? Begin typing a pornstar name, then click on the button to suggest them!
Onward with the medieval-fantasy-solo-masturbation kink! Knight Stick playfully whips his pecker to and fro until he's hard as a boulder! Opting for a more rockin' soundtrack, watch Knight Stick work his beautifully long curved cock. His eyes wince and close in anticipation...almost there!
A hot ebony stud strokes up and down on the shaft of his huge hairy ding dong to make it cum.
Featured in playlists: men solo (18 Videos)
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I found this a very amusing debate.
Quite humorous comments from both sides.
But, the well was already poisoned by Michael Shermer before Lennox started his preconceived spiel.
Lennox made every mistake Shermer already gave an answer to in his first argument.
Lennox continually used the following fallacies:
"It is not possible to:" (An argument from ignorance, is following and a Dunning-Kruger effect ( "I Know") bit of nonsense is…Continue
Added by Dyslexic's DOG on February 14, 2015 at 4:00pm — 4 Comments
Here is an interesting video, linking the Bible and the events with Astrology.
12 Disciples represent the 12 constelations.
The resurrection after 3 days, represents how the Sun appears to become frozen (dies) for 3 days, in the equinox and then appears to start its return (resurrection).
The similarities between all the Sun gods such as Mithra, Horus and Jesus, also point to this astrological basis for the Bible and Jesus Christ.
The Death on the Cross,…Continue
Added by Dyslexic's DOG on February 1, 2015 at 6:30am — 3 Comments
I've been a fan of Steve Shives's work into reading and interpreting Christian Apologetics in a rationalist manner.
Steve is a very rational person and he pretty much destroys most of Christian Apologetics.
Here is Steve's appraisal of "I Don't Have Enough Faith To Be an Atheist" by Norman L. Geisler and Frank Turek. He exposes the writer's biases, bigotry and naivety.…Continue
Added by Dyslexic's DOG on January 7, 2015 at 6:52pm — 8 Comments
© 2015 Atheist Nexus. All rights reserved. Admin: Richard Haynes.


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Calling it an "Oklahoma solution" that uses state-produced energy resources, representatives of Tulsa-based utility Public Service Co. of Oklahoma urged environmental officials Monday to approve a plan that phases out its last two coal units at a power plant near Oologah by 2026.
Public Service Co. of Oklahoma touts 'Oklahoma solution' to regional haze as industrial consumers fear costs
They were opposed by groups of industrial and business consumers who want to keep coal as a low-cost option for the utility's electricity generation.
The public hearing at the Department of Environmental Quality in Oklahoma City gathered comments on PSO's plan to deal with emissions affecting visibility at federal parks and wilderness areas.
PSO wants to retire one of its Northeastern Station coal units in 2016 and install emissions-control technology on the other unit. The utility will incrementally step down the operating capacity of the remaining coal unit over five years until its retirement by 2026.
PSO charted its own course on regional haze after coming to a settlement last year with the Environmental Protection Agency, Oklahoma Secretary of the Environment Gary Sherrer and the Sierra Club.
Oologah resident Bob Rounsavell, a Sierra Club member, said PSO's plan would be a great start to improving air quality.
"The agreement will bring about environmental benefits resulting in significant health benefits," Rounsavell said. "By 2026, sulfur dioxide emissions from the Northeastern plant will be eliminated. Elimination of mercury and other toxins from burning coal will also be eliminated and will help improve health conditions, especially for Oologah residents."
Bud Ground, PSO's manager of public affairs, said the utility's plan was better than a federal plan put in place by the EPA when it partially rejected a state implementation plan for regional haze. The federal plan calls for installation of expensive dry scrubbers.
"We knew we could come up with something that was better, lower-cost, better for our customers and better for our company than installing $800 million or so worth of control equipment on 30-plus-year-old coal units," Ground said.
PSO said its plan could cost $350 million and raise customer rates by at least 11 percent beginning in 2016.
Concerns expressed
The Oklahoma Industrial Energy Consumers, a group of large industrial users, said PSO's plan could cost six times more than the federal implementation plan for regional haze.
Continue reading this story on the...